Provider Demographics
NPI:1598738734
Name:LEEDS, SCOTT M (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:M
Last Name:LEEDS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:415 N CRESCENT DR STE 225
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-6809
Mailing Address - Country:US
Mailing Address - Phone:818-850-0183
Mailing Address - Fax:310-777-0159
Practice Address - Street 1:415 N CRESCENT DRIVE
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210
Practice Address - Country:US
Practice Address - Phone:310-777-0159
Practice Address - Fax:310-777-0160
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2020-05-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA79005207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABQ989ZMedicare PIN